Permit ca.
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Ill I. CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00493
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/6/2007
PARCEL: 1S133DD-03100
SITE ADDRESS: 12852 SW WINTER LAKE DR ZONING: R-4.5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 LOT: 070 JURISDICTION: TIG
PROJECT: NAGANUMA
Project Description: 60' water service. •
CLASS OF WORK: OT R GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 60 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
NAGANUMA, KATE P + TRAVIS J
12852 SW WINTERLAKE DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 11/6/2007 $72.50
[TAX] 8% State Surcha 11/6/2007 $5.80
Phone : 503- 348 -9758 Total $78.30
Contractor:
POWER PLUMBING CO
P O BOX 19418 REQUIRED ITEMS AND REPORTS
O
PORTLAND, , O R 97280 ,
Contact # : PRI 503- 244 -1900
FAX 503- 244 -8825
Reg #: LIC 52378
PLM 34- 150PB
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 246.6699 or 1.800.332.2344.
•
Issued By: �� Permittee Signature: 4 372
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FROM POWER PLUMBING , 5 2007 16:39/ST. 16:38/No• 6860422998 P 1
kiumbing Permit Apolicatio I)'";: I ill: c)1 I ii. 1 1 Ni. t)\I 1
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City or Tigard /_ O r
13125 SW Heft Blvd., Ti Fax:. OR 7223 NOV 5 2 1 ' G - _ f� / i r
III
Phone: 503.639.4171 Fax: 503.598 NO B Rgvicw
r' DatOp - Other Permit No.,
1 1 , Inspection Line: 503.639.x175 1
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Internet, Line: gard-0r.g 1 C1T I Ut ii �.• r ; fi ` ® SetPage1for
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❑ New construction ❑ Demolition For s, cial l ormarlon use cticctfist •
Descri . in ir� Ea- Total
onfi nt 0 Other. . New 1- 2 dwellings pa (includes 100 ft. for each utility connection)
;`' .)` - `• • r • -•r :•-•: SFR (I) bath 2492_0
1- and 2- family dwelling Q Commercial/industrial SFR (2) bath 350.00
❑ Accessory building 0 Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 4
❑ Other. - f ire spnnkler ( sq. R ) Page - ���
— T l)t sere P 1 ?ATOM A ND' LOCATION Site utilities
Job site atidresx 11 Sp (1 t i v r . Catch basin or area drain 16.60 1
City /Statr/l_[P: joiQ/i ,� J a Drywell, leach line, or trench drain j 16.60
Suiteobldg./am : no.: C" ' Project ���,- name: Nn /�, � „�
�m., Footing dram (no. linear R.. Pap 2
Cross street/directions to job site:
�/ Manufactured home utilities 111 110.00
,. Manholes 16.60
R ain drain connector 111111 16.60
• Sanitary sewn (no. linear It: Page 2
Storm sewer (no. linear ft.. ) Pagc 2
Subdivision! Lot no.: Water service (no. linear ft.: 40, I Page 2 5 °i) '
- Fixture or item
Tax ma
p/parcel no.: •
- Absorption valve I 16.60
I +/'1 131f�9IR'nTloN OF WORK $sckftow prey enter 3
,p�.t- Ll0 l 1 t.“--- .t)(,c,P Backwater valve 16.60 1
Clothes washer 16.60
Dishwasher 16.60 i
f , P110frarric Oman l' , I NANP Dnektttg founnun 16.60
Ejectors/sump 16.60 1 .
Name:
Expansion tank 1660 �
Address: Seui.-e_ A.4 abQ✓„`, Fixture/sewer cap 16.60
City/State2IP' - -1 L (/ Floordraittffioor sinklltub 1660 ; '
Phone: (, o� ) 3 tl f c 1 5 a — Fax: ( ) Garbage drat 16.60
- ` : t,�., aglitter =sag Hose bib 16.60
Business name: r P J l , P 4, Ice maker 16,60
p � 1 �A , 1 y Interceptor /grease trap 16 60
II l
Contact name: A 4J1 1 1.'�, • Medical gas (value: $ 1 Page 2
• Address Pa f �( 14•94 Primer 16.60
' City/Stater - cy Cr-y, Roof drain (commercial) 16.60
Phone ( I y- ' Cj bb [ F ax: ; ( )�,yy -. kg2 5 Sink/basnt/levatar 16.60
E -mail-
Tub/shower /shower pan 16.60
� _ Urinal 16.60
;., . . -
.: -• .. � '�� � Water closet I6,60
Business name: / / Q Water heater 16.60
Address: --i .. . d.,- tiw. 1 - L ./.' J ! if Other:
City /State /ZIP• l6 6)( q 7 1 lg Subtotal -� 60
Phone: ( ) (1 ) �✓ , lj sk6 25 r✓
Fax: ( ) ,
CCB Lie.: I 3'7 Plumbing Lic. no.:3 1,50 Plan review (25% of permit fix)
• Authorized signature: C— State surcharge AL P lbe)
J TOTAL PERMIT FEE '7 30 l
Print name: I) R./ 3 _ ! . r► S ,O I Dam: f ) /A7 I This Permit ai rm
tloa expires if a peit is sat obtained *OM
3 i l / • la days ante it bas beta .cam pi td as txmples e-
•Fee method°bq' set* Tri -Camay Huildaag industry Saviem Sound-
, 1Bu , imLegemuaawUa.Y.■mAraaoc 0612606 «o4atettta=pp
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00493
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/6/2007
Phone: (503) 639 -417 Y'111
Inspection Requests (24 Hrs.): (503) 639 -4175 :_
INSPECTION WORKSHEET FOR DATE: 11/14/2007 TIME: 7 :02AM PAGE: 63
SITE ADDRESS: 121352 SW WINTER LAKE DR CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 LOT #: 070 TYPE OF USE:
PROJECT NAME: NAGANUMA
DESCRIPTION: 60' water service.
OWNER: NAGANUMA, KATE P +TRAVIS J, PHONE #: 603.348.9758
CONTRACTOR: POWER PLUMBING CO PHONE #: 503 - 2441900
Inspection Request Scheduled For: Date: 11/14/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 059676 -01 503. 936-1930 N
ICI JO L
Corrections/Comments/Instructions:
i ...A 11■4
itA
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 01 Date: 119 I O 7 Phone #: (503) 718-